Doctors Who Createhttp://www.doctorswhocreate.com
Mon, 21 May 2018 10:00:42 +0000en-UShourly1https://wordpress.org/?v=4.7.10Combating the decreased attendance of women at breast and cervical cancer screening testshttp://www.doctorswhocreate.com/combating-the-decreased-attendance-of-women-at-breast-and-cervical-cancer-screening-tests/
http://www.doctorswhocreate.com/combating-the-decreased-attendance-of-women-at-breast-and-cervical-cancer-screening-tests/#respondMon, 21 May 2018 10:00:42 +0000http://www.doctorswhocreate.com/?p=1766Breast and cervical cancers are considered the most common cancers amongst women, and the American Cancer Society estimates the incidence of breast and cervical cancer for 2018 to be 266,120 and 13,240, respectively. Unfortunately, fatality due to both is high, with the poorest prognosis occurring when the cancer has metastasized. If detected early enough, mortality rates drop significantly. And yet, doctors still struggle to convince women to undergo screening tests for breast and cervical cancers.

There are many risk factors for breast cancer, including a woman’s history of reproduction and contraception, alcohol intake, and family history of the disease. Screening tests include a mammogram (X-ray of the breast), which is largely considered the best way to detect early breast cancer. Breast MRIs are used along with mammograms to screen women who are at high risk for getting breast cancer. The American Cancer Society recommends that women should have the opportunity to begin annual screening between the ages of 40 and 44. Cervical cancer, on the other hand, is caused by a virus transmitted via sexual contact, called human papillomavirus (HPV). Getting screened regularly increases the likelihood of diagnosing the cancer before it advances in stage, which can drastically reduce life expectancy— according to the American Cancer Society, the 5-year relative survival (2007-2013) for localized cervical cancer is 92%, compared to only 17% for distant. The screening test is called a Pap smear, where cells are scraped from the cervix and examined under a microscope.

Despite the advantages of getting these screening tests done, many women are very hesitant to do so. According to a study at Western Sydney University, an overarching reason for this is that these tests require partial nudity, which makes a number of women highly uncomfortable. To address this issue, a hospital in Thailand’s Kamphaeng Phet province, inspired by “The Mask Singer” television talent show, came up with a creative solution called “The Mask Pap Smear Campaign.” The hospital staff prepared masks for women, which they could wear during their breast or cervical cancer screening. In some instances, the medical staff also wore masks to make the women feel more comfortable when registering for the tests. The results of this campaign were very impressive, with up to 50 female mask-wearers turning up for the free screening tests compared to fewer than 20 women from before the campaign.

The Procter and Gamble Corporation in Taiwan adopted another creative strategy. It targeted the developing trend of Taiwanese women having afternoon tea by coming up with the slogan, “Save a life in six minutes.” It claimed that getting a screening test could be as quick and easy as drinking afternoon tea. The face of this campaign, supermodel Lin Chih-ling, said that the afternoon tea concept was developed in the hopes that each woman would cherish her health. This turned out to be very effective, as awareness of the screening tests rose significantly.

What these campaigns have in common is that they took the women and their cultural contexts into consideration. The Mask Pap Smear campaign focused on the unease of women at the idea of partial nudity. The afternoon tea campaign related the screening tests to something commonplace – afternoon tea – so women would be more comfortable with the former. Scaring women with statistics and mortality rates is an ineffective way to promote health screening tests. In order to combat these cancers, providers should consider the needs and concerns of women.212

I read Dr. Rana Awdish’s book, In Shock, from cover to cover on a six-hour flight from Philadelphia to San Francisco. I started it expecting to read for just an hour or two and then nap, but I just couldn’t put it down. It’s a suspenseful personal story of surviving a near-death experience, but that wasn’t the only thing that made it riveting. What transfixed me were the lessons that Awdish drew from the experience, which she interspersed throughout the book, and the raw emotions she shared. Having just finished clerkship year, and seen some of the lapses in humanity towards patients that she describes, reading this book was cathartic because she finally put in words so much of what I already felt needed to be changed in medicine.

From the very outset of this book, you know that Awdish will eventually end up in her own ICU, but you also know that she will survive to tell the tale, write a book about it, speak about it around the world, and get back to work as a physician. Even so, each part of the story feels suspenseful. A particularly poignant moment occurs when she goes to the ER, pregnant and in pain, knowing that something is deeply wrong. A resident is ultrasounding her belly, and Awdish realizes with agony that there is no fetal heartbeat, and says so out loud. The resident, green with inexperience, asks, “Can you show me where you see that?” Awdish writes: “I realized the resident’s perspective in that moment was aligned squarely on himself….The insensitivity of what he was asking struck me hard. I felt invisible to him. His detachment reveals an unsettling, largely unspoken reality. We aren’t trained to see our patients. We are trained to see pathology.” I read that and knew that I had seen and participated in many moments like that in the hospital, which still bothered me months later.

There are patient memoirs and physician memoirs, but sometimes we forget that physicians are patients, too. And a memoir from the perspective of an ICU physician becoming an ICU patient is filled with a certain level of in-depth detail and knowledge of the system and its frustrations. For example, when Awdish is taken from the ICU to get a CT scan, she reflects: “It was just a CT scan. I thought of how many scans I had ordered on my patients. How many everything I had ordered. It was shocking how little thought I had given to what it meant to leave the safety of the ICU, to be bumped and jostled and made to lie flat with lungs filled with fluid from heart failure or pus from pneumonia. How pathetically arrogant that I thought only of how clinically useful the images would be, or how necessary the test.”

Awdish’s memoir is full of these moments of self-realization, and she has a gift for language in the way she expresses them. I think that every person in medicine would benefit from reading this book, no matter his or her level of training. As a medical student, it affirmed my desire to value empathy over efficiency, and never lose sight of the importance of communication with my patients.

]]>http://www.doctorswhocreate.com/in-shock/feed/0In Shock in Her Own ICUhttp://www.doctorswhocreate.com/in-shock-in-her-own-icu/
http://www.doctorswhocreate.com/in-shock-in-her-own-icu/#respondMon, 14 May 2018 10:00:42 +0000http://www.doctorswhocreate.com/?p=1749

Rana Awdish, MD, FCCP is an intensive care physician and director of the pulmonary hypertension program at Henry Ford Hospital in Detroit, and is the author of the bookIn Shock, a memoir based on her own experience with critical illness that landed her in her own Intensive Care Unit (ICU). She is now a champion for empathy through connection and communication in medicine, and was named National Compassionate Caregiver of the Year by The Schwartz Center in 2017 and Physician of the Year by Press Ganey in 2017.

When I overheard a physician describe me as “trying to die on us,” I was horrified. I was not trying to die on anyone. The description angered me. Then I cringed. I had said the same thing, often and thoughtlessly, in my training. “He was trying to die on me.” As critical care fellows, we had all said it. Inherent in that accusation was our common attribution of intention to patients: we subconsciously constructed a narrative in which the doctor–patient relationship was antagonistic. It was one of many revelatory moments for me.

When I read Dr. Awdish’s piece in NEJM I knew I had to read her memoir, and it was every bit as compelling and resonant as her piece was. I was able to chat with her over the phone about her path to medicine, and how her experience with critical illness led her to rekindle her art, empathy, and desire to share her story.
—Vidya: What drew you to medicine in the first place? Were you also writing at an early age?Dr. Awdish: I only ever remember wanting to be a doctor. It always spoke to me. I saw how our family viewed our pediatrician as a hero after he saved my brother’s life (the story is in the book’s introduction). I really admired how much knowledge he had and how he was able to apply it in this really human way. I also really liked art, but I had this sense that I could always use art in my life. I felt that if I had a talent in science, then I should pursue it because I could do more good with both art and science than I could do with only one.

Vidya: When you were in college and medical school, did you continue painting and expressing yourself in that form?

Dr. Awdish: Not at all. I remember in medical school, I was completely into the science. I was so focused on learning the craft that I didn’t feel like I had room for other things. There was an 8-year period where I didn’t really watch TV, so I have a vacuum of current events knowledge. When I met my husband, I think every joke he made was about Seinfeld, and I didn’t know what it was. I think I seemed like an alien to him. I had left art behind: I didn’t write, I didn’t paint, I wasn’t doing anything creative. Looking back on it, I wish I had left more space for it. I always enjoyed art museums, so I would still make time for that, but I wasn’t creating.

Vidya: When did you start creating again?

Dr. Awdish: When I got sick in 2008, and was so physically limited, there was this period where I just could barely leave a chair or my bed, much less the house. I have an active mind and personality, and I felt like I needed to be able to do something, but I hadn’t really gotten all of my language back from the hypoperfusion and shock. I still felt cognitively slow and inarticulate, so reading and writing wasn’t really available to me yet. I could lose myself in painting. I had all these thoughts and emotions that were bubbling up that I didn’t know what to do with, and putting visual imagery to it really helped. I wasn’t very good at it, but I enjoyed it so much. It was a very important part of my life at that time.

Vidya: I know in the book you share some anecdotes about how moments of empathy were seen as weakness in medical school.. How do you think your illness influenced your thinking about those moments and medical culture?

Dr. Awdish: I felt like I wanted to fit in during medical school. Medical students are young, and there is this club you’ve wanted to join your whole life. If someone tells you implicitly or explicitly, “This is how we talk in this club, and this is how we act,” you start to adopt those behaviors if you want to fit in. What I can say is that it never felt comfortable to me. It never felt good or like we were advancing the care of the patient when we distanced ourselves from the emotional impact of patient suffering and patient care. I think part of what we don’t talk about in medicine, especially as women, is that we’re representing a traditional male archetype in medicine, a sort of stoic, unfeeling, distant father figure.

I did an interview with a journalist who asked me, “Is there anything you wish you had put in the book that you didn’t?” What that caused me to reflect on was that I took subconscious effort not to over-identify as a woman in the book. I didn’t want to be perceived as a female doctor; I wanted to be perceived as a doctor. I thought it would discredit my voice, and I’m sort of mad that I bought into that.

Vidya: I think it’s fascinating and amazing that you were able to write this book about your own experience in your own hospital. When did you first think of writing about your experience, and what was it like taking that to the form of a book?

Dr. Awdish: It’s been a process. I first wrote a short article about it a few years ago in an academic journal, and that was really my first brush with writing about it. I started speaking about my experience at the Sepsis Day lecture that I mention at the end of the book. The video of that circulated on the internet and a literary agent reached out to me and said “You’ve got a great story here, and I can see by how you talk about it that you really love words, and I think you should write a book.” And I was like “Haha that’s funny.” But eventually I spoke to my husband, and he suggested that I could offer this as a resource to students and residents. So that was how I approached it. I had two rules for myself: one, it was going to be the truth. If people looked bad, they should have acted better at the time, because I was just writing what happened. And two, after writing it, no one has to see it. I think that uninhibited me in a way that was liberating. I wasn’t thinking about an audience, I was just thinking about me. I didn’t show anyone my writing at the hospital until it was in bound galley [the pre-publication version], which meant it couldn’t be changed, not a word of it. It was done.

Vidya: And did they know about it, at that time?

Dr. Awdish: They knew. I showed it to them when I was done and I remember expecting to be fired. It was a risk I knew I had to take. I was speaking my truth and I knew I could stand behind it. And when they read it, it was amazing. It was the complete opposite of what I expected. Everyone was like, “Yeah, this is who we are. Now we can talk about it.” Anyone who works in healthcare knows this is all true and it all happens everywhere all the time. They bought 4,000 copies for all the leadership, passed them out, started book clubs, and put me on every stage they could in order to share my story.

Vidya: If you could go back to when you were a medical student or a resident, what would you do differently?Dr. Awdish: I think I would tell myself what I tell medical students today: “Don’t believe the lie.” Don’t believe that you have to change yourself to fit the culture of medicine. Be yourself and let medicine move to fit you, because you are healthier and more whole than medicine is right now. Model good behavior, because a lot of what you see in the hospital is dysfunctional. And people know it’s dysfunctional, they just don’t know another way. So if you can care and be present, let people see that. That’s how culture change has to happen.

How does one visually depict the topic of anatomical donation and cadaver dissection, memorializing the donors’ ultimate gift to medical education while preserving the sanctity of their bodies? “Intimate” is one of several pieces created surrounding the theme of anatomical dissection and in memory of the anatomical donors who serve as the budding medical student’s “first patient.” Drawing inspiration from Frank Netter’s iconic illustrations that have accompanied generations of physicians in their training, this piece emphasizes the power of touch that pervades not only in the learning of human anatomy but all facets of clinical practice and healing. This and other works by the artist were showcased at Harvard Medical School’s annual anatomical donor memorial service in Jan 2017.

The Aseemkala Initiative uses traditional dance to perform stories of women in medicine. Using choreography, interviews, and research, we use our diverse styles to tell our diverse experiences as patients and providers. We are looking for choreographers and researchers to join the team! Consider applying here: https://aseemkala.org/opportunities/

]]>http://www.doctorswhocreate.com/applications-open-for-aseemkala-initiative/feed/0Psychiatry and the Selfhttp://www.doctorswhocreate.com/psychiatry-and-the-self/
http://www.doctorswhocreate.com/psychiatry-and-the-self/#respondMon, 23 Apr 2018 19:44:37 +0000http://www.doctorswhocreate.com/?p=1699To make art is to examine the self. To practice psychiatry is to examine the other, in relation to the self. Both are phenomenological. They are inextricably linked, and bidirectional. As a psychiatrist, I heal and comfort patients who suffer from immense physical and psychological pain. We form a therapeutic alliance based in curiosity and exploration, and partake in a journey of discovery. We are guided by biological underpinnings, social determinants of health, and psychological conflicts at varying levels of psychic accessibility. Together, we examine how affect and self-esteem are regulated, and explore the sources of these cathexes. When I paint, I do the same. I examine my own incontrovertibly human conflicts: the paradigms of self and non-self, idealization and devaluation, control and chaos, love and aggression. My art surprises me, embarrasses me, excites me, fills me with shame and dread — all inevitable human experiences. In that way, more than anything, my art connects me to the human experience, and thus connects me to my patients.

Three Yiayias in Mourning
24” x 36”
Acrylic on canvas

Red as a Beet, Mad as a Hatter
40” x 30”
Acrylic on canvas

House Cleaning

24”x 24”

Acrylic on canvas

Blue Ridge Worms

24” x 36”

Acrylic on canvas

125th St.

36” x 36”

Acrylic on canvas

Pregnant on the 1-train

40” x 30”

Acrylic on canvas

Self-disintegration, in Pink
36” x 24”
Acrylic on canvas

]]>http://www.doctorswhocreate.com/psychiatry-and-the-self/feed/0Art as Escape: The Dual Life of a Patient and Resident Doctorhttp://www.doctorswhocreate.com/art-as-escape-the-dual-life-of-a-patient-and-resident-doctor/
http://www.doctorswhocreate.com/art-as-escape-the-dual-life-of-a-patient-and-resident-doctor/#respondFri, 20 Apr 2018 10:00:38 +0000http://www.doctorswhocreate.com/?p=1697Dr. Anita Raj is far from your traditional doctor-in-training. Born and raised in Brossard, a suburban town south of Montreal, Dr. Raj was diagnosed with craniopharyngioma at a young age and began folding origami as a distraction from the countless doctor appointments, surgeries, and medical complications implicated in her diagnosis. Growing up with unique and intimate insight into the patient experience inspired her not only to become a doctor herself, but also to share her artistic outlet with others. As a current first-year family medicine resident at McGill, an artist, and healthcare provider, Dr. Raj continues to contribute to her community in novel and transformative ways.

As an artist on the path to becoming a physician, I was particularly intrigued by Anita’s unconventional path in medicine and the influential role origami has played in her journey thus far. I reached out to her to continue the conversation and gain more insight into her extensive experiences as a patient as well as her long-time passion for origami and how making art influences her medical education and residency to this day.

IC: Before you became a doctor, you were a patient. Can you tell me more about this journey growing up?

Dr. Raj: When I was six years old, I started having headaches, double vision, nausea, and vomiting. My parents took me to the Montreal Children’s Hospital. It took quite a while for the doctors to figure out what was going on, but they eventually figured out that I had a brain tumor. Everything happened pretty quickly after that. They took really good care of me, so it wasn’t too long before I was scheduled for two surgeries. I had one surgery to put a shunt in, and four days later, I had the eleven-hour long surgery to remove the tumor. Recovery after that was a long process. I have to take medications and supplemental hormones for the rest of my life because of my pituitary. I continued to get regular MRIs and eye check-ups I would see the endocrinologist regularly, so there was lots and lots of follow up.

Two years later, one of the MRIs showed that the brain tumor came back, so they decided they would do radiation therapy instead to get rid of it. So that, interestingly enough, was done at the adult hospital in Montreal, the Montreal General Hospital. I was the only kid sitting in the waiting room for adult radiation therapy. And that took about a month of therapy.

When I was in Grade 10 of high school, during my mid-year exams, I started having these weird headaches. Through a bunch of tests, they found that my shunt was blocked. They ended up replacing it and doing another surgery.

Since then, I have been diagnosed with other things, like migraines, IBS, allergies, and sleep apnea. I also get tired more than other people my age. I used to run around with kids and be super active and play at lunch time, but since I got sick, after the surgery, I became more isolated just because I didn’t have the energy to play with all the other kids. Growing up, going outside or doing extracurriculars and all sorts of socializing activities was difficult for me; they took so much energy. For example, going out to go shopping with friends only four blocks away was like, “I’m sorry I can’t because I know I won’t be able to go there.”

IC: This naturally leads to our next hot topic for discussion: your origami. Tell me more about this and what drew you to origami in particular.

Dr. Raj: I got interested in origami as a kid. When I was younger, my brother used to actually fold with me. We used to get books from the library, and I would ask him for help. And somewhere along the way, I saw a little girl folding paper stars—they are called lucky stars. They are little stars folded out of strips of paper. They really intrigued me in elementary school, so I started to fold them because she showed me how. At one point, she also started to fold these stars out of straw as well, but she wouldn’t tell me how she made them.

I ended up going to Montreal’s Chinatown, looking for straw and instructions on how to do them. I went on this whole quest to find out. I finally did, and in that whole process, I found other sorts of origami that I also tried to fold. I started off folding these modular origamis. Basically you fold a bunch of little triangles and you assemble them to make shapes, like swans or peacocks. I also got into basic modular and geometric origami at this point. Later, I started discovering more complex origami, more complex forms that were folded from one sheet of paper. I started to get more into that and other geometric forms. I also started to get different kinds of paper.

Throughout elementary school and high school, it became something I could do when I was alone. And I was often alone at lunch time and in my free time. It was something to distract me from all the hospital appointments and medical complications and pain. It has continued to serve that purpose until now, essentially. I think pretty much the whole way through, it has been an integral part of my life. It’s one of the things that keeps me going.

IC: Has this led to an interest in sharing your art or dabbling in other artistic mediums?

Dr. Raj: It has been origami up until recently. I sort of developed the art form in terms of finding new papers and techniques, such as wet folding, which is when you moisten the paper with water so that you can shape it in a smoother way. I also started to teach people. Before I got into med school, I was volunteering at the Children’s Hospital where I grew up. I would go and fold with some of the kids while I was volunteering, so that was really nice. I also volunteered and folded at different events, like the Brain Tumor Foundation’s fundraising walk. More recently, I’ve attended groups and shared my love for origami with women who are battling cancer.

One to two years ago, I somehow got into painting by going to local Michael’s painting classes. It was strange for me because I remember in elementary school I had the choice between music, art, and drama classes, and I always chose music. I liked origami, but I was so close-minded that I thought painting wasn’t worthwhile!

A couple years ago, something clicked and I said, “I want to try this.” I took some classes in acrylic painting, and then I thought that was too difficult, so I got into oil painting and now I guess I am flip-flopping between the two to learn new techniques.

IC: Does origami and painting share something in common for you?

Dr. Raj: They both help distract me from my residency life and work in general. The process of creating something is just so rewarding, relaxing, and gives me a sense of accomplishment.

IC: Have you found that this passion for making art is common in the medical school / residency community?

Dr. Raj: I actually now know two people who do origami while attending med school, so I get to chat with them, which is nice. This year, I’m working with a club called McGill Humanities and Arts in Medicine. It was initially founded by four students in my class three or four years ago and was only focused on the humanities, so I was like, “Hey, why don’t we try to get some art in here.” Eventually we ended up arranging an exhibit at a hospital known as The Glen, where we exhibited works of patients, doctors, nurses, and other healthcare professionals, so pretty much anyone involved in healthcare. We called it “Journeys through Health”.

Recently I also published a magazine with works from medical students and students in other health professions as well. It was basically a magazine to showcase their art and writing and how these affect their life, whether it be pieces that distract them from their life as a medical student or help them to reflect on their life. We had a bit of both. I wanted them to have a voice. There were other universities in Canada who had a similar concept going, but we hadn’t had anything like that.

IC: How do you see art influencing your role as a doctor? Do you think this has changed how you navigate a clinical encounter?

Dr. Raj: It’s a bit difficult to answer because medically, I have been through so much that not a lot of people or medical students have been through. I know what it is like to go through so many surgeries, MRIs, shunt caps; I know what it is like to go through tests, to take so many medications and forget them. It gives you a different perspective. But if I had to think of the role art plays in this, I would say that it makes me more open, non-judgemental and understanding of how people cope. Someone else might be surprised, but I would understand how and why patients cope through non-pharmacological methods such as art. We are always taught to find non-pharmacological methods and then move onto pharmacological tools. For example, if you see a psychiatric patient you might recommend a self-therapy book for them to read. It brings new ideas to your mind in general.

IC: Are there any other exciting projects or events happening that you would like to share with us?

Dr. Raj: I actually created my own origami models and got them published in different places, such as a book collection published by the British Origami Society and online and print publications of Origami USA. So that is something I am working on—creating my own forms.

There are also origami conventions and exhibitions. I also recently got into an exhibition. It’s a goal to go to a convention one day, but because of my health and med school, I haven’t found the time to go. But eventually! They recently had an exhibition in Quebec City, where they got works from all over the world. They saw some of my folds and asked for some of them. So I recently got my work displayed at this really nice exhibit, which I am hoping to post photos of on the Facebook page I am creating.

One of the things that has me super excited brings me back to where Istarted. The Children’s Hospital recently moved to a new building, where they now have these display cases built into the walls. I got to know the curator at The Glen, and she asked me if I wanted to decorate the display cases with my origami, according to different themes for the kids. They are mostly in waiting areas, and we are creating little scenes and themes for the kids to look at, like underwater themes, the tortoise and the hare, and a penguin and ice theme. I’m happy and nostalgic about this incredible opportunity to decorate the place where I grew up.

IC: And your paintings?

Dr. Raj: I am also submitting my paintings, including two that I will submit to an annual exhibit at the local city hall! I am working on some for YouTube tutorials as well.

I also completed an oil painting for a medical museum at McGill. The museum has different specimens collected over decades, many of which were collected without consent from people who passed away. They have an incredible assortment, from congenital anomalies and fetuses to specimens from every part of the body that you don’t think of. It’s a growing museum at McGill, and the curator, who is a pathologist, asked me if I could create something to commemorate the museum and all these people who had, in a sense, donated their body parts to the museum—although technically they were taken from them. So I was asked to make a painting for the museum acknowledging this so that is hanging up right now. It’s a huge oil painting, 30 x 40 inches. I think it acknowledges how much we appreciate that we are able to see these things that not everyone actually has the access to see.

IC: Any words of wisdom for fellow doctors-in-training?

Dr. Raj: Given everything that I do art-wise, the most important thing would be to continue doing things that you like, activities that you enjoy doing because those are the things that are going to keep you going during medical school, residency or any other healthcare program you might be in. The stress of it is immense and dealing with patients can often affect you in different ways, and it’s really important to have an outlet, whether to reflect on things that have happened or distract you from those things.

If you’d like to check out more of Anita’s original origami work, visit her Flickr page and follow her on Facebook.

]]>http://www.doctorswhocreate.com/art-as-escape-the-dual-life-of-a-patient-and-resident-doctor/feed/0Healthcare Design Bootcamp, June 7-8http://www.doctorswhocreate.com/healthcare-design-bootcamp-june-7-8/
http://www.doctorswhocreate.com/healthcare-design-bootcamp-june-7-8/#respondSun, 08 Apr 2018 15:31:22 +0000http://www.doctorswhocreate.com/?p=1692Apply here for a 2-day program at Jefferson University that will provide you with an immersive experience in how to apply design thinking in a health care context. You will learn and be exposed to design skills that are relevant in the education of health care providers and the delivery of clinical care. The bootcamp will have group activities, team presentations, and exercises in prototyping and testing.

]]>http://www.doctorswhocreate.com/healthcare-design-bootcamp-june-7-8/feed/0An Ambidextrous Neurosurgeon Balances Medicine and Visual Arthttp://www.doctorswhocreate.com/an-ambidextrous-neurosurgeon-balances-medicine-and-visual-art/
http://www.doctorswhocreate.com/an-ambidextrous-neurosurgeon-balances-medicine-and-visual-art/#respondFri, 30 Mar 2018 10:00:01 +0000http://www.doctorswhocreate.com/?p=1684Dr. Kathryn Ko is an ambidextrous neurosurgeon and artist from New York City. She did her medical training from Mount Sinai Hospital, and in 2012, completed a Masters in Fine Arts degree from the Academy of Art University in Representational Painting and Drawing.

HB: How did you find yourself at the intersection of art and medicine?

Dr. Ko: I was actually a writer as a pre-teen, and continued writing through residency. I then started weekly night classes for drawing, but wasn’t very good at it. I became frustrated and decided that either I had to get better, or move on. That’s how I found myself pursuing a Masters in Fine Arts. It has been a lot of fun. The intersection has enriched both my medical and art careers. And having a degree has made my art more legitimate and acceptable to other art professionals.

HB: Do you think you always had a knack for art?

Dr. Ko: I believe my skill in drawing came from my formal art training. Painting is very complicated. You have to know the optics behind it to make your paintings come to life. You have to understand the visible spectrum. I didn’t know if I would ever get good at it, and that’s something I want people to take from my story. You don’t know what potential you have until you try. You can go through life thinking that you will try something new when you’re older, and have more time, or you can start making time to take up new challenges and surprise yourself by what you’re capable of.

HB: How does being ambidextrous fit into your story?

Dr. Ko: I was born right-handed, but taught myself to be ambidextrous. I am a very kinetic learner, which is most likely why I got into surgery as opposed to a more sit-down kind of medical specialty.

As a medical student, I wasn’t able to concentrate during lectures. My mind would wander, and so to keep myself alert, I started using my left hand to take notes. That’s how I started using my left hand, but it took me years to get comfortable using it. My dominant hand for surgeries is still my right hand, but the primary reason for that is that most surgical instruments are right-handed.

Becoming ambidextrous has been very beneficial, and I encourage other people to do so. It makes your mind more alert and flexible, since you’re teaching it such a fundamental skill. It also reduces the burden off one side of your body.

HB: What types of art do you pursue?

Dr. Ko: I paint, which is a huge time commitment. They can take half a year, depending on their size and which hand I’m using. I also work with a friend (@_deathcabforchloe) on cartooning, a lot of which is related to women in medicine. Cartooning is my medium for humor.

Other than that, I also write for an online journal, where I have a department called “Neurosurgeon Studio.” I also do a lot of medical videos, pertaining to topics in neurosurgery such as surgical techniques with a medical student from Tokyo (@med_school_radio).

HB: Where does the inspiration for your pieces and their titles come from?

Dr. Ko: A lot of my art is based on medical scenes, generally based on montages or impressions. One piece was based on a young patient, Eric, whose family I grew very close to over the years.

The titles come naturally to me, perhaps because of my background in writing. For example, I made a self-portrait called Craniotopy and Gsharp, because the drill emits a sound that is G sharp.

HB: How do you find time to manage and balance both your professions?

Dr. Ko: Neurosurgery takes priority over art. That’s why I did not pursue an art degree until my medical career was well established. Every painting is a huge time commitment and I don’t want a situation to arise where I’m knee deep in a painting, but then have to discard it. That’s why cartooning can be more fun. It’s quicker, and I don’t have to think it over before starting it. Lack of time is also why I use social media (Instagram: doc_ambidexter) to promote my art and what it represents rather than via galleries.

HB: How has your experience changed your overall approach to things?

Dr. Ko: I’ve learned that if you are interested in something, you should give it a shot. It doesn’t matter if you fail. You should try to accrue a mass of knowledge on the topic, and explore your potential in it.

]]>http://www.doctorswhocreate.com/an-ambidextrous-neurosurgeon-balances-medicine-and-visual-art/feed/0Resident Screenwriterhttp://www.doctorswhocreate.com/resident-screenwriter/
http://www.doctorswhocreate.com/resident-screenwriter/#respondMon, 19 Mar 2018 10:00:09 +0000http://www.doctorswhocreate.com/?p=1671Roshan Sethi, MD is a PGY3 in Radiation Oncology at Harvard. He is also the co-creator of the new medical drama The Resident on Fox and a screenwriter for the upcoming film Call Jane. His other writing credits include Black Box and Code Black. He completed his undergraduate studies at Yale and received his medical degree from Harvard Medical School.

SW: When did you first become involved with the entertainment industry?

Dr. Sethi: In 2009, when I was a first-year medical student, there was a show made about Harvard Medical School called HMS. I reached out to Amy Holden Jones, the writer, and asked to be a consultant. I sent her a lot of ideas for the show and eventually she invited me to become a consultant in an official capacity. After that, we did eight pilots together, and eventually her show Black Box went to series on ABC. I began working with one of the writers on the show, Hayley Schore [co-creator of The Resident], and we wrote a sample that got us an agent. She staffed us on a show called Code Black on CBS. At the end of intern year, I took a year off before starting my Radiation Oncology residency. And at the tail end of my year off, I wrote a version of The Resident with Amy and Hayley for Showtime. They eventually passed, but months later, after I had returned to residency, Fox picked it up.

SW: How do you manage to juggle your clinical duties with your TV responsibilities?

Dr. Sethi: My program, Harvard Radiation Oncology, gives me a lot of flexibility. I get time off to go to meetings and set. But it really is very difficult. I get up early every morning and write. That’s when I do most of my writing. I write very fast and have a writing partner, which makes things easier, but it’s still very stressful.

SW: What is a typical day like for you?

Dr. Sethi: I get up really early, like 4am. I write like a crazy person, usually in the hospital cafeteria, and then I spend the rest of the day as a resident.

SW: Do you see any parallels between medicine and entertainment?

Dr. Sethi: They’re so different, but writing and medicine are both about understanding people. And as doctors, we tell stories all the time, in rounds and in notes and when we talk to each other casually about patients.

SW: One of the main characters on The Resident is an Indian American and another is a Nigerian immigrant. What are your thoughts on diversity and representation in entertainment?

Dr. Sethi: In medicine I’m surrounded by Indians and Asians and Nigerians, and there’s so much diversity. The cardiac ICU is like India. But on TV, how many Indian doctors can you name? They are few and far between. Why is that? I once worked with a director who was casting for a cab driver role and he wanted someone with a turban, a long beard, and an accent. When I asked him why, he said it’s realistic because so many cab drivers are Indian. Because that’s the priority – being realistic. When it comes to medicine, where does that need for ethnic realism go? It has a lot to do with the fact that most content is created by white people, so they naturally create the world the way they see it. And they see Indians in cabs.

I will say, however, that it’s something everyone is eager to change. There was no pushback from the studio, network or producers to casting an Indian or Nigerian doctor character on The Resident.

Grey’s Anatomy was a revolution in terms of diversity on TV. Half of that cast was minority doctors, and nothing was ever made of the fact that they were minorities. And now a whole generation has grown up watching that show, and people of color can imagine themselves as physicians in a way they might not have from watching other shows.

SW: Do you have any other creative projects in the works?

Dr. Sethi: During that year I was working for Code Black, I started writing features with Hayley. We’ve now written eight movies. Three are in active development. We almost exclusively write about women and minorities. Three of the movies are period biopics about different women in science. One of them is about Kalpana Chawla, the first Indian to go into space with NASA. Another is about Rosalind Franklin, who had her work stolen by Watson and Crick. And the other is about a woman who worked in the Jane Collective, which performed underground abortions in the 60s before Roe v. Wade was passed.

SW: When will we get to see them?

Dr. Sethi: Not for a while. Call Jane, the movie about abortion, has Elisabeth Moss and a director, and will hopefully be shot this summer. The others are not as far along. It’s very hard to get non-comic book movies made.

SW: Devon went to Yale, then Harvard for medical school. You also went to Yale and Harvard for medical school and are currently a resident. Is The Resident art imitating life?

Dr. Sethi: [Laughs] He has my Step 1 score, too! But that’s where any resemblance ends. I think I’m more like Conrad. I’m pretty blunt, direct and forceful.

SW: You bring medicine into the creative field through your writing. Are there ways that you bring creativity into your practice of medicine?

Dr. Sethi: I don’t know that I bring creativity, but I will say that screenwriting is constantly useful as a physician. In screenwriting you work to put subtext underneath the dialogue to make it more interesting. It’s the same thing in a medical encounter because people rarely say what’s on their mind. I’m always trying to decipher the subtext in patient dialogue. We never get taught in medical school and residency how to really hear patients. I find this particularly interesting in conversations about cancer. If someone asks, “How big is the tumor?” they really (ultimately) want to know, “Am I going to die?” And you have to find a way to answer the question beneath the question.

SW: What do you think sets The Resident apart from all of the other medical TV shows?

Dr. Sethi: I think it has a point of view, in particular about medical error. At times it does go too far. At the end of the day, it’s a dramatic network show. But I admire it for having something to say. There has been some negative feedback from doctors. Some is valid, some unfair. Someone once emailed me and said that that residents don’t wear ties. And I was literally sitting in the hospital wearing a tie, reading his email. I wanted to send him a photo of myself. But I read everything that’s written about the show and I try to understand how it can be better.

A lot of the criticism has focused on whether the show makes patients afraid of the hospital. I hope it makes patients advocates for their care. They should question if every test or intervention is truly necessary. We shouldn’t be afraid of patients asking those questions. We shouldn’t be afraid of being accountable.

SW: Do people at work – colleagues or patients – know about your TV writing?

Dr. Sethi: Patients do not, because it never comes up. And, anyway, nobody wants a doctor who is a screenwriter. But my attendings let me go to LA and my co-residents cover for me while I’m away, so they all know. I am very grateful to the people in my program who make it possible for me to write.

SW: How do they react?

Dr. Sethi: A lot of my co-residents watch every single episode. I get a lot of texts when the show is airing from people who want to give live feedback.

SW: What’s the most powerful moment you wrote into The Resident?

Dr. Sethi: I really like that the first CPR you see on the show doesn’t end positively. It’s important for people to know CPR doesn’t always work and, even when it does, it doesn’t work in the larger sense. Believe it or not, most of what people know about CPR comes from TV.

SW: Who are your role models?

Dr. Sethi: My mom, because she is the ultimate hustler. She was an immigrant to Canada and accomplished whatever she wanted by sheer effort. She’s a general practitioner. My twin brother and I worked in her walk-in clinic. We wore matching outfits and sat at the front desk. When someone walked in, we would chorus, “Welcome to Dr. Sethi’s office.” People would ask, “Is he in?” and we’d say, “She. She’s our mom.” We were basically just there to be little feminist twin boys.

Like many of my generation, I spent my childhood outdoors. I scooped up tadpoles from the pond next door, watching them sprout limbs and turn terrestrial. I trapped backyard fireflies in glass jars on warm June evenings, spending hours of observation trying to discern the secrets of their random flickers. I poured plaster of Paris into animal tracks in the woods, which I later carefully lifted from the forest floor and added to my bedroom shelf collection.

Oliver Sacks, in the early essays of his 2017 collection The River of Consciousness, takes a child’s inchoate curiosity of nature to a whole new level. In an essay titled “Speed,” we learn that the young Oliver photographed fiddleheads in his English garden hour by hour, developed the negatives, then arranged them in little flip-books so he could watch in seconds the unfurling of their crosiers, which took days in real time. Similarly, he captured the wingbeats of butterflies into up and down movements with the help of his cousin’s cine camera.

In this literary tour de force, Sacks links the worlds of botany, neurology, physics, and psychology by effortlessly invoking the works of a great many scientists, researchers, physicians and experimenters—some famous, others little known, some gone with the ancients, others friends and colleagues of the famed neurologist. We learn (or are reminded) of Charles Darwin’s discovery that plants are not self-pollinated but are fertilized by insects; Spencer Jennings’s proposition that single-celled protozoa, in effect, learn and remember; Eric Kandel’s reporting of face recognition in a species of paper wasp. All of these miracles of science are related back to Sacks’ own life and come to us wrapped in the gleaming bow of his wide-eyed wonder. Of evolution, Sacks says, “I rejoice in the knowledge of my biological uniqueness and my biological antiquity and my biological kinship with all other forms of life. This knowledge roots me, allows me to feel at home in the natural world, to feel that I have my own sense of biological meaning, whatever my role in the cultural, human world.”

The subject Sacks explores that may be of prime interest to the Doctors Who Create community is in the essay titled “The Creative Self.” He notes that one foundational requisite in the development of creativity is imitation and apprenticeship, in which the future artist absorbs lessons from famous painters, sculptors and authors by studying their work. All art, in other words, is derivative in some degree, highly influenced by earlier art and artists. What sets creativity apart from mere mastery of style and form involves an active interplay, an assimilation or incorporation of the talents underlying the creative process with one’s own life experience; an imposition of personal depth and meaning on the work.

In a related essay called “The Fallibility of Memory,” Sacks draws distinctions between intentional plagiarism and cryptomnesia, where a forgotten memory is recognized anew in a person, not as a memory but as a novel thought or creation. He notes that there is no way for events of the world to be recorded directly as truths in our brains. Every “truth” is experienced and interpreted uniquely by individuals. “Our only truth is narrative truth,” he explains. “The stories we tell each other and ourselves.” After reading The River of Consciousness, I am only glad that Dr. Sacks has shared his truth with us.

Ian Drummond is a rising fourth-year medical student getting his MD-MBA at Case Western Reserve University School of Medicine. In 2016, he launched a podcast called The Undifferentiated Medical Student, which aims to empower medical students in the process of choosing a medical specialty. For the podcast, he is interviewing one physician from each of the 120+ specialties listed on the American Association of Medical Colleges Careers in Medicine website; he has already published interviews with 64 physicians.

After discovering Ian’s podcast, as a medical student unsure of how to choose my future specialty, I reached out to him to hear what motivated him to start a podcast in medical school, and what it has been like to embark on this creative endeavor.

Vidya: What motivated you to go into medicine as a career? Were you sure about that, or where you “undifferentiated” between many careers?

Ian: Like many others in medicine, I liked science, I liked helping people, and I saw that being part of human relationships was very special and there was a great chance to have those relationships in medicine. Your decisions matter in medicine, you have a lot of responsibility, and I really liked that. And there’s also probably an element of financial security that you’re not allowed to talk about on the interview trail. Before applying to medical school, I was actually playing minor pro ice hockey in Sweden. I remember thinking, as I was playing in this minor league, which was so much fun, that there were a lot of 35-year-olds. I didn’t want to be still playing in the minor leagues when I was 35, even if I was having a blast. I realized that if I didn’t make a decision about the future direction of my life, I could easily spend the next ten years of my life doing something that would have been fun, but ultimately not satisfying.

Vidya: When did you get interested in podcasts?

Ian: I got into listening to podcasts at the beginning of medical school. I got to medical school in 2013, and I quickly realized that I didn’t have a whole lot of free time outside of studying. I found podcasts to be a wonderful way to get an infusion of something that wasn’t medicine, and it went a long way to helping me feel well-rounded about myself and more like a complete person. Especially during studying for Step 1, I was like, “Oh my god, medicine better be what I want to do because I literally have no time to do anything else.” I realized that on the walk to school and back, or when I was making breakfast, or doing the dishes, I could be listening to a podcast while doing those things. I could deep-dive into anything I was interested in, and I think it went a long way in preserving my sanity.

Vidya: Are there any medical ones you listen to, or do you stay away, because you get so much of medicine through being in medical school?

Ian: Yeah, very few medical ones. I do have two: one is called The Doctor Paradox, about how people come into medicine really passionate to practice it, and then they burn out. The podcast is an exploration of what physicians do to take back their careers. And then Behind the Knife, which is a surgery podcast. I interviewed the doctors who runs the podcast, he’s here in Cleveland.

Vidya: What made you want to start a podcast? How did you do it?

Ian: The Undifferentiated Medical Student podcast is about choosing a medical specialty and planning a career in medicine. I was struggling with those things. I came in first year not knowing what I wanted to do, and the administration and upperclassmen told me I’d have plenty of time to figure it out during third year. But I got to halfway through third year and was like, I don’t really know what I want to do. I saw a lot of grumpy interns and grumpy attendings. I didn’t have a clear picture of what I wanted to do with my life, and so it was kind of a forced stop, to take some time to figure this out. I have this creative streak, and I like podcasts, and so at the end of my third year, in June 2016, I took some time off and started making a podcast. I just looked up how to do it, did YouTube tutorials, and started interviewing people. During that year off, I also worked at a medical device startup.

Vidya: What kind of response did you get when you launched the podcast?

Ian: Not much of a response, initially. It was about 20 downloads a day—it was probably all my mother. I launched in November of 2016, and then slowly the word spread, especially as I amassed more interviews. In January of 2017, I got a big break. I talked to the admissions officer here at Case Western, and he sent out an email to all the admissions officers, and then I went from 50 listens a day to 1,000 a day, and that was the beginning. Now the podcast has about 300,000 downloads.

Vidya: Has this process helped you choose a specialty? Are you still undifferentiated, or leaning towards something now?

Ian: I think I am finally starting to differentiate. I started out thinking Orthopedic Surgery, then I was like, maybe Internal Medicine, but it’s completely different. Then I discovered Med-Peds. Then I thought, if I like adults and kids, and I really enjoyed my Ob-Gyn rotation and my Psych rotation, why not Family Medicine? Then I realized that I like the inpatient setting better. Not even Med-Peds felt totally right, though, and I enjoyed my Surgery rotation but not that much—I really realized you had to love the operating room. I liked the OR, it was a happening place, and that’s where Anesthesiology came into the fold. They aren’t tied to the OR, like surgeons are, but they get to do procedures, and I realized that there’s a lot of medicine in Anesthesiology. I liked kids, and wanted to be sure that was part of my process, so I have ended up on pursuing a combined Pediatric-Anesthesiology residency.

Vidya: Did making the podcast, or any of the podcast interviews, help with that decision?

Ian: You know what, it did. I was editing episode 34, anesthesiology with Dr. Daniel Lee, he’s the program director at UC San Diego. At one point he was like, “Hey Ian, I want to make sure to mention the combined programs.” And I didn’t really hear him say it during the interview; I registered it, but I was thinking about my next question so I wasn’t contemplating it as deeply as when I was editing the audio. There was a light bulb moment and it was the first time in all of medical school that I actually started thinking about what I have to do to look good in the eyes of residencies. This was the first time I was forward-looking, and not just stuck in place. Another thing he said was that because you have this wide scope of practice in Anesthesiology, working with kids, adults, medicine, procedures, and context switching from the wards to the OR, you become an expert in two spheres of the hospital. This gives you a better idea of how hospitals function in general, which lends itself to eventually being a dean of students or being in management. That’s kind of where the MBA comes into the picture.

]]>http://www.doctorswhocreate.com/ian-drummond/feed/0Process: Reflections from the Path to Doctorhttp://www.doctorswhocreate.com/1618-2/
http://www.doctorswhocreate.com/1618-2/#respondTue, 30 Jan 2018 11:00:47 +0000http://www.doctorswhocreate.com/?p=1618Over the past year and a half, I have been compiling an anthology of reflections from medical students, junior doctors and residents from around the world about their experiences in medicine. The anthology, provisionally called Process: Reflections from the Path to Doctor, is now under contract with University Press of New England.

Unlike similar collections, the anthology focuses on the trainees themselves, and highlights the psychosocial implications and effects of medical training. I hope the collection serves as therapy of sorts to medical trainees and builds a sense of camaraderie among colleagues around the world.

Process will also give aspiring medical trainees better insight into medical training and provide patients and community members with an understanding of the forces that shape their doctors.

On a larger scale, I hope the anthology will spur necessary conversations about the successes and shortcomings of our current health education systems.

The anthology is open to submissions till March 10, 2018. It will be a wonderful to have a variety of voices and perspectives in the collection.

Martin Hess sat with arms crossed in the family doctor’s waiting room. This was the third doctor he’d visited in as many months. Frustration and fear called up an image of Ben, who recently sat right where he was, before his nightmare began.

Ben and Martin were friends from the local gym and had both celebrated their 40th birthdays together last June when Ben got the news about his kidney cancer. In six months he went from fitness buff to skin and bones. He had been gone almost a year now and Martin still shuddered to think of how that disease ravaged his friend.

Three months earlier, when two or three Advil no longer had much effect on his back pain, Martin went to an urgent care center. He struggled to describe his pain to the medical assistant who was engrossed in her computer data entry. “It’s pretty bad but worse on some days, maybe not the worst pain I’ve ever had and I just wondered if…maybe I’m overreacting but my friend…”

“The doctor will be in shortly,” she interrupted, then hit the last computer key like a pianist’s final recital note and dashed out the door.

The doctor was friendly when he came in the room, but then was all business. So you have back pain–upper or lower? How severe? Where is it exactly? How long have you had it? Have you had it before? And so on. As he climbed onto the exam table, Martin caught a glimpse of the computer screen where the assistant and doctor entered their notes. “Poor historian,” it said at the top of the page, but the rest a series of check boxes that he could not decipher.

The doctor prescribed an anti-inflammatory and muscle relaxant, and suggested he call if the symptoms worsened, or were not resolved in a week or so. After taking his medicine later that night, Martin imagined a tumor mass slowly growing and eroding into his flesh and vital organs.

He knew he needed follow up, but was reluctant to return to the urgent care physician who seemed harried and inattentive. This time Martin went to a local primary care clinic, a satellite of a reputable regional health system.

Dr. Kay was energetic, and seemed eager to help. Martin began to recount his experience at the clinic, trying to convey his frustration that his pain did not respond very well to the anti-inflammatory medicine, when Dr. Kay broke in.

“I hope you are not expecting any narcotics–we don’t do that here,” she said abruptly.

“Do what?” Martin asked, feeling suddenly confused.

“Pain management. That is just not what we offer here. Too many people want us to handle their narcotic prescriptions and we just can’t provide that service. I would be happy to refer you to a Pain Management center though.”

Now Martin had gone from confused to bewildered. Was this the curse of the so called “poor historian?” Pain management sounded good–maybe that doctor would know how to diagnose and treat him. He mulled over possible responses until his temples throbbed and neck muscles tensed and he just blurted it out.

“OK, send me to pain management.”

“Thanks for understanding.”

As it turned out, the pain management clinic was not in his insurance network and would cost him $400 for an initial consultation.

So, Martin decided to query some of his co-workers about their doctors.

Marlene, a manager spoke up first.

“I’ve been with Dr. Athy for ten years now, and I really like him.

“What do you like about him?” Martin asked.

“His staff is friendly, and he never seems rushed. He answers all of my questions,” Marlene replied.

Sandy walked him down a long, brightly lit corridor and into a neatly appointed exam room.

“The doctor is running about fifteen minutes behind schedule, but you are his next patient.” Her smile put him at ease.

Soon came a knock on the door. “Hello Mr. Hess, I’m Dr. Athy. It’s a pleasure to meet you,” he said extending his freshly sanitized hand for a shake. His white coat, no tie look exuded a relaxed professionalism.

“You can call me Martin,” he said, returning the polite handshake.

“OK Martin,” Dr. Athy said, “Tell me how I can help you today.”

“It’s my back. It’s been bothering me for about 3 months. I don’t want to say too much. That hasn’t gotten me very far.” Martin said, careful not to utter a word about pain medications.

“Tell me more. It sounds like there is a story here,” said Dr. Athy, his eyes showing sincere curiosity.

Martin hesitated, but then started to speak, recounting his story from the beginning. After a minute or so, he asked, “Should I continue? I know you are busy.”

“No problem Martin, go on.”

Martin continued, telling Dr. Athy about his symptoms, saying that he had been referred to something called Pain Management, even though he had no idea what was wrong with him.

“That must have really frustrated you,” the doctor said.

When Martin finished his story, Dr. Athy asked a few follow up questions, performed an examination, then moved away from the computer pulling his chair up closer to Martin.

“I have a few thoughts about the cause of your pain, but first I’d like to know what you think it could be from. Have any possibilities crossed your mind in the last month?”

“I guess… It’s probably nothing, a strain or something,” Martin said.

“You don’t sound sold on that. Is there something you are especially worried you could have?”

Martin wasn’t sure what to say. The doctor sat silently while Martin deliberated with himself for what seemed like an hour, before saying, “My friend died of kidney cancer last year. He had back pain too, and I can’t help thinking of a cancer inside of me.”

What a tremendous relief it was to get that out. It was like he had been living in clothes that were two sizes too small for months and he finally found the right fit. The back pain even seemed to ease.

Dr. Athy reassured Martin that the character of his pain did not indicate a kidney problem, but said that he could understand why he was worried. Martin felt less foolish and ignorant admitting his true concern. Dr. Athy suggested another trial of anti-inflammatories and some stretching exercises. He also recommended a follow up visit in two weeks to evaluate Martin’s progress.

As he thanked the doctor and prepared to leave for the checkout, he recalled what he saw on the computer screen at the urgent care center.

He turned back and asked, “Dr. Athy, what does it mean to be a “poor historian?”

“Well,” the doctor said with a little hint of a smirk, “That’s what we say when we’re not listening carefully enough.”

Dr. Fred Foote enlisted in the Navy during the 1970s, working as a hospital corpsman before spending his undergraduate years at Middlebury College, St. Johns College Annapolis, and the University of Chicago. After graduating in 1980, he went on to earn a medical degree at Georgetown while in his 30s and he subsequently pursued a residency in neurology at Yale.

He spent his years in clinical medicine as a Naval physician, working at sea for 6 years and spending most his time at Bethesda Naval Hospital until it combined with Walter Reed. Since 2000, Dr. Foote has been focused on pushing for the utilization of holistic medicine to treat wounded soldiers.

After 29 years of service, he retired in 2009, but he continues to work with the military from his home base in Bethesda, Maryland. In addition to his clinical work, he has published a book of poetry, Medic Against Bomb: A Doctor’s Poetry of War, spearheaded the Green Road Project, directed the Warrior Poetry Project, and led the Epidaurus Project to implement holistic care in the Military Health System. He is now a scholar at the Institute for Integrative Health in Baltimore. He continues to practice some clinical medicine and he is currently working to become certified in acupuncture.

After driving around in his dented Honda Civic (which remains dented so he can identify it), I had the chance to interview Dr. Foote as we sat in the beautiful natural environment of the Green Road on the Walter Reed grounds.

Ryan: What prompted you to join the Navy?

Dr. Foote: I’m a military brat and every male in my family that we can record back for 1500 years has been in the military, so there wasn’t really a choice. I’m not a military type of person and my real love is poetry. We raised money for the Green Road Project with the proceeds from my book.

I originally joined the Navy when I was 19, first to pay for college, and never thought I’d be staying for 29 years. To some extent, the military is my family. I understand them and I don’t always fit in that easily with them, but I love them and so it made sense to me to continue to serve the military through my medical career.

Ryan: You picked the specialty of neurology, but the work you are doing seems to fall more along the side of psychiatry and psychology. How has your specialty helped or hindered you in these areas?

Dr. Foote: People always wanted me to go into psychiatry and I always resisted that. I guess I wanted more of a hard-nosed science approach. But, I am comfortable with psychiatry and I do somewhat of a minor in it as a neurologist. The two are really the same, and the more forward-looking training programs are now combining psych and neuro into neuropsychiatry which is a good thing to do for a person going into the field.

Ryan: How did you come up with the name and function of the Epidaurus Project?

Dr. Foote: Back in 2000, when I tried to develop holistic medicine here, I gathered together a working group of renowned scholars to define the nature of patient-centered care. Because I had visited the Greek medical school at Epidaurus when I was young and I was struck by the beauty of it, I named the whole project after it. Epidaurus in Greece was home to the 6th century BC Hippocratic medical school and it is still a beautiful site today.

Ryan: How does the Military Health System stand in its efforts to employ holistic medicine?

Dr. Foote: At this point, we lead the nation in this area. Part of the reason is that we have the money to try things in the middle of a war. We also have an urgency. The real driver in the last 10 years has been having had an enormous number of casualties with brain injury and PTSD. Conventional care did not work very well for those conditions, so we had to find a fix because we could lose the war by running out of people if we couldn’t get those soldiers back to active duty. There has been tremendous emphasis on new therapies, allowing us to capitalize on that to make new holistic medicine projects.

The basic theory of my work over the past 20 years has been based on the fact that there are two types of medical care. There is organ system medicine, in which you treat one part of the body at a time, and there is whole body medicine, which is less used, but has a rich history. The components are evidence-based design, family centered care, integration of care, and wellness (including nutrition, exercise, stress management and, alternative medicine), and healing through the arts and nature. All of them treat the whole body rather than just one organ, something that we are trying to harmonize with conventional care. We’ve tried these and they have worked.

Ryan: Tell me about the inspiration for your book of poetry, Medic Against Bomb.

Dr. Foote: The trigger for that particular book was my deployment to the Iraq War in 2003 on the hospital ship Comfort. That was where I treated the war-wounded myself for the first time. That led to a lot of poems which became my first book, Medic Against Bomb. It was published in 2014 and has done very well. We needed a way to raise money for the Green Road and the Arts Program. We were raising money from civilians, but we had to have them understand the life of a soldier to raise money from civilians. It turns out that if I say 10 minutes of poetry and show images of the wounded warriors to a civilian audience, they instantly understand and give money. I’ve raised over $500,000 for the Green Road with those readings across various civilian audiences: as varied as medical groups, arts groups, car dealerships, universities, and business people. Everyone responds to the impact of poetry when it’s about something they feel strongly towards. You could say that Medic Against Bomb has been the face of the wounded warrior for this project and others. Another similar book that is worth checking out would be Here, Bullet by Brian Turner. He is a good friend of mine who has worked with the Creative Writing Program at Sierra Nevada College in California.

Ryan: What are some interesting stories you have about your experiences with this work?

Dr. Foote: When you come to the Green Road, it’s a total gestalt effect. We’re accustomed to thinking poetry and medicine are totally different, but they’re not. Everything really is connected. You can move people to a healing place or engage people to do medicine through art and poetry. I’ll tell you a story about the impact that it has had.

In June, I was invited to present poetry and the Green Road at the international literary festival in Busan, South Korea. Once I had accepted the invitation and I was on the way there, the U.S. State Department decided that it would be good idea for me to talk about these things to a wider Korean audience. The embassy in South Korea commissioned 10 presentations for me throughout the country to talk about how the military was using art to heal patients. The response of the Koreans to this was overwhelmingly positive. It really is true that you can cross boundaries with art and medicine. You don’t have to live in silos and remain isolated. Life can grow organically, like these trees around us.

Ryan: How long have you been involved in writing poetry?

Dr. Foote: I started as a teenager and then I had a hiatus in my 20s. I thought poetry was making me crazy. I was crazy, but it wasn’t the poetry. By 1995 I figured that out and my poetry came back to me, so I’ve been writing steadily ever since. I have several manuscripts that aren’t just about the military.

Ryan: You’ve faced a lot of resistance to these treatments during your time in the medical field. What has led you to persist in the face of such opposition?

Dr. Foote: It was loyalty to the military and love for the soldiers that helped me. You’d die for these soldiers any day since they are just such salt of the earth people. You really develop a love for them that drives you. That’s the main force pushing us all in military medicine.

The military is a difficult place to innovate in. The military’s job is to control, channel, and manage violent behavior. This is a difficult task to do, so they must be very conservative, bureaucratic, and authoritarian in nature to complete it. These traits lead to years of peace being years of stagnation. Ironically, to bring out this other side of medicine for healing, we have needed a war. We may develop things more rapidly during war since we have an extra push to improve the kind of care we offer. The Iraq and Afghanistan wars have provided the impetus for us to improve care and to employ my ideas.

Ryan: What is your biggest piece of advice for anyone interested in combining medicine and writing?

Dr. Foote: That’s a difficult question. First of all, say that it is possible. You’re going to have very few free hours, but the two will feed each other. The art helps you become a better healer and the healing gives you a lot in the realm of art.

My most basic advice would be, to save time, you should give up TV. I don’t even have one myself!

]]>http://www.doctorswhocreate.com/holistic-healing-in-the-military/feed/0Tattoohttp://www.doctorswhocreate.com/tattoo/
http://www.doctorswhocreate.com/tattoo/#respondWed, 10 Jan 2018 11:00:28 +0000http://www.doctorswhocreate.com/?p=1600I asked my
dying patient today
if she had any regrets?
She said,
I wish I
had gotten a
tattoo but
I don’t know what I would’ve gotten it of.
Is there anything more human than that?
To want to have
something permanent to
stamp stand by
in surety
on your arm
on your skin
but not be sure what exactly, yet, still.

Goodbye my dear
You’re “getting the hell out of here”
Swollen feet
Refusing oxygen
These lungs, gasp
are the best lungs, gasp
(she loves her transplant)
Breathing is your prerogative

I don’t even know your name
Or if you’re dead yet
Just a hospital room number
Silver 1101

I think that
eleven floors down
there is a resident tattoo artist
Who tattoos nipples
onto reconstructed breasts
so they look like real breasts
It seems kind of pointless, and painful
16 needles and four tubes in your skin already
the rest of your life
maybe 48 hours
I want a tattoo, too
The funny thing is I haven’t decided what I want yet

]]>http://www.doctorswhocreate.com/tattoo/feed/0The Doctor as Patient, Part III of VIhttp://www.doctorswhocreate.com/the-doctor-as-patient-part-iii-of-vi/
http://www.doctorswhocreate.com/the-doctor-as-patient-part-iii-of-vi/#respondFri, 05 Jan 2018 11:00:34 +0000http://www.doctorswhocreate.com/?p=1594This is part III of a series by Dr. Erika Landau that documents her experience as a physician battling breast cancer.Link to Part ILink to Part II

After I felt the lump, I made an appointment with a radiologist friend. They did a mammogram, my first ever. It was negative and I nearly went home happy and with an appointment for next year. My friends, please all of you have a mammogram at some point. Tell your doctors your family history. Follow up with an ultrasound if necessary.

Being a physician myself, we did discuss the role of ultrasound, because we both felt that the small lump, which was located in the right upper quadrant, was indeed suspicious. He did an ultrasound. He called me in the reading room and showed me the results.

“There is a little something here,” he said. “Maybe we should follow it up. I do not have any other images with which to compare. Let us do a biopsy, it will be ready in a week and I am sure it is OK. It will be fine.”

He did not sound worried. I was sure it was fine, after all the mammogram was negative. The lesion, not seen on the mammogram, was in the right upper quadrant, which I know can be suspicious but I did not give it a second thought. Hey, better safe than sorry; I will do the biopsy.

Now that I think about it, I felt more tired than usual and had some finger numbness and back pain. When I went to a neurologist, he told me that I was, most probably, depressed. This is why I do not go to other doctors. When you are a woman, you are either pre-or post-menstrual and/or have other hormonal problems. You are depressed or it is in your head. He did discover that my Vitamin D was low, so, there you have it, it was an answer. Please, to student and practitioner readers, do not say this to women. Yes, indeed, the hormones and certain emotions always play an important role in our lives, however there is so much more to the female pathology.

Did anyone have cancer in my family? My mom and her sisters, my father and his family, all Holocaust survivors, were relatively, at least physically healthy. I lost all grandparents, aunts and uncles in the concentration camps at Auschwitz, Dachau, Matthausen. I never even knew what they looked like. My family history has huge, never to be recovered gaps, forever lost in the gas chambers.

I stayed very late in the office after the phone call, I finished the work but I just could not get myself going home. The reality of the diagnosis was setting in, I had to face it, I could not drown it in work as I often tend to do with most of my problems.

I finally went home and despite my husband’s reassurance, I did not sleep that night. I kissed and hugged my daughter even more than usual, which raised serious protests from her part. At this age, they do not like to be snuggled like they did before. I always tell the parents to take the hugs and kisses while they can…

The next day, I talked to the pathologist.

The biopsy showed that the tumor was almost one centimeter and already out of the duct. I understood that if not for the ultrasound, I would have never known and next year, when I would have been due for my annual mammogram, it would have been too late. The panic set in again.

Another year has passed by quickly, and we’ve been excited to share new content and ideas from writers around the world with you in this past year. We remain ever-thankful to you for being a part of the Doctors Who Create community. We rely on your feedback—your emails, your tweets and facebook posts, your conversations—to improve each year. I started this organization in 2015 in reaction to a thought in the back of my mind that had grown too persistent to ignore—the fact that the medical training process and culture often seemed to promote conformity instead of creativity. I felt that we needed visible role models and conversations to change that. That sparked the Doctors Who Create website, and in 2016 we were able to grow into a larger team, and publish more varied and interesting content. In 2017, we have expanded that team (who you can read about on our About page), published more guest posts by contributing writers, and started more partnerships with organizations that share similar goals. We have also made an effort to promote our mission at medical conferences.

Reflections on profound conversations with patients by Dr. Jeffrey Millstein

We showcased the artwork of intern Mike Natter, “Calloused Fingertips,” a self-portrait made entirely out of his used blood glucose test strips. The painting now hangs at the Juvenile Diabetes Clinic at the Diamond Health Care Center (Vancouver General Hospital).

I presented Doctors Who Create at the Hippocrates Poetry in Medicine symposium, a conference held this year at Harvard Medical School attended by physicians, poets, and poetry researchers from around the world. The symposium occurs annually and accepts poetry submissions here.

DWC artist Lizz Card took home the first prize at the Frank H. Netter Symposium on Arts and Health this year for her painting “Mahosot Surgery I.” Check out some of her contributions on DWC, including her unique brainstem cross-section squish paintings here (maybe the most creative way to appreciate neuroanatomy!)

https://www.instagram.com/p/BaJfJ95nrSY/?taken-by=doctorswhocreate

We got an inside look at the Mütter Museum, founded in the mid-nineteenth century in Philadelphia and a hub for medical specimens, oddities, and art, when our staff writer Chieme Ohanele interviewed the museum educators about its role in educating the public on the intersection of art and medicine.

I presented Doctors Who Create at the medical innovation conference Stanford MedX in September. The conference was a unique mix of patients, providers, and designers: you can read my take on it here.

Our newest social media manager, psychiatry resident Jihan Ryu, has allowed us to expand our Instagram presence with the creation of quoteboxes highlighting the creative physicians we profile in our series “Profiles in Creativity.” Follow our Instagram account here to #getinspired !

With every post this year, I was inspired by the hard work that went behind it—from our daily dose editors Ekta and Chris, our Profiles in Creativity editors Eugenia and Esha, our arts editors Mike and Kathryn , our social media experts Ananya, Jihan, and Samantha, our writers, artists, podcast, and strategy team, our physician-advisor and my mentor Dr. Amy Waldner, and last but not least, our editor-in-chief Stephanie Woo, who spearheaded all of the work you see linked above with the help of our hardworking managing editor Lauren Kim. Every member of our team is passionate about our mission of promoting creativity in medicine, and carves out precious time to make it happen: I am so privileged to work in their company.

Thank you for joining us in celebrating all the creativity above this year. It’s tough making and keeping resolutions when the majority of our volunteer staff is immersed in medical training, but here are a few goals we have for 2018:

Getting our podcast off the ground! (Interested in helping out? Please contact me at vidya@doctorswhocreate.com if you have any sound editing or podcasting skills, we would love your help).

Starting a book review section for books by physicians.

Partnering with more organizations that share our mission.

Promoting our stories on other media outlets.

Growing our social media presence

Fundraising so that we can grow our staff, reach a larger audience, and hold events in the future.

Planning a Doctors Who Create conference, hopefully featuring many of the creative physicians we’ve profiled for our Profiles in Creativity series

Thanks for making it to the end of the year-in-review post! Tweet us (@doctorscreate) to let us know which piece of 2017 you enjoyed the most, and/or what DWC content you’d like to see in the new year!

Dr. Dara Kass works at NYU/ Bellevue Hospital and is the founder of FemInEM, an open access resource that allows members to discuss, discover, and affect the journey of women working in emergency medicine. Dr. Kass was previously the director of undergraduate medical education at NYU and Assistant Program Director at Staten Island University Hospital. She completed her residency training at SUNY Downstate/Kings County Hospital. She is active in both the Academy of Women in Academic Emergency Medicine (SAEM) and the American Association of Emergency Physicians (ACEP). Alongside the growth of FemInEM, she has developed a niche in the advancement of women in emergency medicine. She is invited regularly to speak on topics such as professional development of women, unconscious bias, and achieving gender equity in Emergency Medicine.

I came across Dr. Kass and her organization FemInEM through my own work as an emergency medicine resident physician, and asked to interview her to learn more about the inspiration for FemInEM and the steps she took to create it.

Dr. Waldner: What inspired you to start FemInEM?:

Dr. Kass: I realized I was having many individual conversations with women in medicine who were struggling with the same challenges, like maternity leave, promotions, or salary discrepancy. Instead of having the same conversations with women repeatedly, I wanted to create an open access resource where members could connect and share advice on how to approach similar challenges. The initial vision was for this resource to provide a community where women in emergency medicine could feel empowered to ask for what they want; whether it be a promotion, working part time, or a contract negotiation. I wanted it to serve as a tool for empowerment. The real inspiration was to make myself obsolete, so that eventually, these issues don’t exist and we won’t need FemInEM.

Dr. Waldner: What was it like building an organization while being a physician?

Dr. Kass: It is so fun! It’s a completely organic process. I had no idea when we started that we would be where we are. I couldn’t have imagined it. I intentionally try not to think about a 5 or 10-year plan but rather build in frequent reassessments. The real goal is to take new directions when the need arises. For example, all of a sudden we realized we needed to have a conference. We needed to provide a faculty development resource for women to cultivate the skills they need to be successful. So we developed the FIX17 conference and it was a huge success.

Dr. Waldner: Can you talk about the successes you experienced as an organization?

Dr. Kass: There have been so many. The biggest has been the disseminated effects FemInEM has had on the landscape in emergency medicine. One example is the Speakers Bureau. It was common in the past that the majority of speakers at conferences, grand rounds, etc, were men. So we created a searchable database of female speakers that organizations can utilize when selecting speakers. As a result, we have seen an increase in the number of women who are invited to give grand rounds talks. We’ve also seen females in residency championing the movement. They feel they belong to a community and further disseminate the advancement of women throughout the pipeline. These are huge successes!

I think the organization’s success is in its infrastructure. The individuals who want to be involved are driven to be part of the mission. They’ve found a place to park their academic niche that is non-traditional. Furthermore, it’s portable. The work they contribute creates a platform for education that can be separate from an academic center, hospital, or residency program.

Dr. Waldner: Your path is so inspiring! How did you do it?!

Dr. Kass: I realized early on that I had to be true to myself. I wanted to be more involved nationally to ensure my skills were transportable. This is so important! As a full-time employee, there is a fine line between a hobby and career. Once your hobby starts consuming a percentage of your time that is significant, you have to decide which one is your side gig. So once I started not picking up shifts in the ER because I wanted to invest in my side hobby, I decided to change the algorithm of how I worked. So I made FemInEM my more prominent career commitment, and being a physician a side gig. I had to be honest with myself about where I wanted to spend the majority of my time and dedicate my nonclinical energy. It’s a huge leap of faith to reframe your center for academic energy. But the gift in what we do is that we need to go to the ER and work. You can work anywhere. So I asked my boss to be per diem so I could still work shifts, but invest more of my energy into the organization.

Dr. Waldner: What has been your personal key to success?

Dr. Kass: I am successful when I am true to who I am. I learned a long time ago that if I’m really frustrated in a circumstance, I need to understand how to work in an environment that I don’t find frustrating. I am really happy creating things that are impactful. I don’t always work well under people but I get a lot and give a lot to those that I work with. I need the right amount of autonomy and I work at a different pace, my own pace. I find success when I can be autonomous and build things the way I want to. This took me a long time to figure out.

Leaving academics was emotionally very difficult. We grew up defined by our academic success. So when you are reframing your success you have to do something that makes you feel secure. I had to reframe and plan my ideas of success and security.

Dr. Waldner: What are your visions for the future of FemInEM?

I don’t know. I don’t want to know. But the next thing for FemInEM is to plan the next conference, FIX18, and deliver things in a sustainable way. I try to hand things off to people that work with me. I start things and then hand them off and empower people to take them on in a new way. We are trying to create things that are loosely related and develop a community and opportunities for the people coming up.